Multiple organ dysfunction and systemic inflammation after spinal cord injury: a complex relationship.

Multiple organ dysfunction and systemic inflammation after spinal cord injury: a complex relationship.

Spinal cord injury (SCI) is a devastating event that results in significant physical disabilities for affected individuals. Apart from local injury within the spinal cord, SCI patients develop a variety of complications characterized by multiple organ dysfunction or failure. These disorders, such as neurogenic pain, depression, lung injury, cardiovascular disease, liver damage, kidney dysfunction, urinary tract infection, and increased susceptibility to pathogen infection, are common in injured patients, hinder functional recovery, and can even be life threatening. Multiple lines of evidence point to pathological connections emanating from the injured spinal cord, post-injury systemic inflammation, and immune suppression as important multifactorial mechanisms underlying post-SCI complications. SCI triggers systemic inflammatory responses marked by increased circulation of immune cells and pro-inflammatory mediators, which result in the infiltration of inflammatory cells into secondary organs and persistence of an inflammatory microenvironment that contributes to organ dysfunction. SCI also induces immune deficiency through immune organ dysfunction, resulting in impaired responsiveness to pathogen infection. In this review, we summarize current evidence demonstrating the relevance of inflammatory conditions and immune suppression in several complications frequently seen following SCI. In addition, we highlight the potential pathways by which inflammatory and immune cues contribute to multiple organ failure and dysfunction and discuss current anti-inflammatory approaches used to alleviate post-SCI complications. A comprehensive review of this literature may provide new insights into therapeutic strategies against complications after SCI by targeting systemic inflammation.

脊髓损伤（SCI）是一种毁灭性的事件，会给受影响的个体带来严重的身体残疾。除了脊髓内的局部损伤外，脊髓损伤患者还会出现多种以多器官功能障碍或衰竭为特征的并发症。这些病症，如神经源性疼痛、抑郁、肺损伤、心血管疾病、肝损伤、肾功能障碍、尿路感染以及对病原体感染的易感性增加，在受伤患者中很常见，阻碍功能恢复，甚至可能危及生命。多方面的证据表明，来自受伤脊髓的病理联系、损伤后的全身炎症以及免疫抑制是脊髓损伤后并发症的重要多因素机制。脊髓损伤引发以免疫细胞和促炎介质循环增加为标志的全身炎症反应，这导致炎症细胞浸润到次要器官，并使炎症微环境持续存在，从而导致器官功能障碍。脊髓损伤还通过免疫器官功能障碍诱导免疫缺陷，导致对病原体感染的反应能力受损。在这篇综述中，我们总结了当前的证据，这些证据表明炎症状况和免疫抑制与脊髓损伤后经常出现的几种并发症相关。此外，我们强调了炎症和免疫信号导致多器官衰竭和功能障碍的潜在途径，并讨论了目前用于缓解脊髓损伤后并发症的抗炎方法。对该文献的全面综述可能会为通过针对全身炎症来治疗脊髓损伤后并发症的策略提供新的见解。